Peroneal nerve injury associated with sports-related knee injury

Cho, Do Sang; Saetia, Kriangsak; Lee, Sangkook; Kline, David G.; Kim, Daniel H.

doi:10.3171/2011.9.focus11187

Cited by 45 publications

(30 citation statements)

References 26 publications

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“…4,5,10,15 Nearly onehalf of patients with nerve involvement may have a permanent deficit, and results of surgical repair have typically been modest, especially with longer grafts. 11,15,19,23,26,30 Increased prevalence of CPN palsy is associated with higher velocity injury mechanisms, 5,21 knee dislocations with posterior cruciate ligament and posterolateral corner injuries, 15 and increased BMI.…”

Section: Discussion Common Peroneal Nerve Injurymentioning

confidence: 99%

“…Common peroneal nerve (CPN) palsy has been reported in 25%-40% of cases. 4,5,10,15 The mechanism has been thought to be a stretch lesion to the posterolateral aspect of the knee. 24 Because of the broad zone of injury seen clinically, patients often fare poorly and do not recover either spontaneously or even when treated with long interpositional grafts.…”

Section: Neurosurg Focus 39 (3):e8 2015mentioning

confidence: 99%

See 1 more Smart Citation

Combined common peroneal and tibial nerve injury after knee dislocation: one injury or two? An MRI-clinical correlation

Reddy

Amrami

Howe

et al. 2015

FOC

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OBJECT Knee dislocations are often accompanied by stretch injuries to the common peroneal nerve (CPN). A small subset of these injuries also affect the tibial nerve. The mechanism of this combined pattern could be a single longitudinal stretch injury of the CPN extending to the sciatic bifurcation (and tibial division) or separate injuries of both the CPN and tibial nerve, either at the level of the tibiofemoral joint or distally at the soleal sling and fibular neck. The authors reviewed cases involving patients with knee dislocations with CPN and tibial nerve injuries to determine the localization of the combined injury and correlation between degree of MRI appearance and clinical severity of nerve injury. METHODS Three groups of cases were reviewed. Group 1 consisted of knee dislocations with clinical evidence of nerve injury (n = 28, including 19 cases of complete CPN injury); Group 2 consisted of knee dislocations without clinical evidence of nerve injury (n = 19); and Group 3 consisted of cases of minor knee trauma but without knee dislocation (n = 14). All patients had an MRI study of the knee performed within 3 months of injury. MRI appearance of tibial and common peroneal nerve injury was scored by 2 independent radiologists in 3 zones (Zone I, sciatic bifurcation; Zone II, knee joint; and Zone III, soleal sling and fibular neck) on a severity scale of 1–4. Injury signal was scored as diffuse or focal for each nerve in each of the 3 zones. A clinical score was also calculated based on Medical Research Council scores for strength in the tibial and peroneal nerve distributions, combined with electrophysiological data, when available, and correlated with the MRI injury score. RESULTS Nearly all of the nerve segments visualized in Groups 1 and 2 demonstrated some degree of injury on MRI (95%), compared with 12% of nerve segments in Group 3. MRI nerve injury scores were significantly more severe in Group 1 relative to Group 2 (2.06 vs 1.24, p < 0.001) and Group 2 relative to Group 3 (1.24 vs 0.13, p < 0.001). In both groups of patients with knee dislocations (Groups 1 and 2), the MRI nerve injury score was significantly higher for CPN than tibial nerve (2.72 vs 1.40 for Group 1, p < 0.001; 1.39 vs 1.09 for Group 2, p < 0.05). The clinical injury score had a significantly strong correlation with the MRI injury score for the CPN (r = 0.75, p < 0.001), but not for the tibial nerve (r = 0.07, p = 0.83). CONCLUSIONS MRI is highly sensitive in detecting subclinical nerve injury. In knee dislocation, clinical tibial nerve injury is always associated with simultaneous CPN injury, but tibial nerve function is never worse than peroneal nerve function. The point of maximum injury can occur in any of 3 zones.

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Section: Discussion Common Peroneal Nerve Injurymentioning

confidence: 99%

Section: Neurosurg Focus 39 (3):e8 2015mentioning

confidence: 99%

Combined common peroneal and tibial nerve injury after knee dislocation: one injury or two? An MRI-clinical correlation

Reddy

Amrami

Howe

et al. 2015

FOC

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“…Fifteen of 43 patients (35%) with a motor dysfunction of the common peroneal nerve in our study experienced a spontaneous improvement of symptoms within 1 year, and one patient experienced improvement even more than 1 year after the injury. Previous studies have demonstrated complete or partial recovery of nerve dysfunction in 40% to 50% of the patients [2,9,22,31]. It is known that a partial nerve lesion has a far better prognosis [5].…”

Section: Discussionmentioning

confidence: 99%

Posterior Tibial Tendon Transfer Improves Function for Foot Drop After Knee Dislocation

Molund

Engebretsen

Hvaal

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…Sports are a relatively common cause of SPN entrapment. Cho et al [62] evaluated 448 cases of peroneal nerve injury; 84 cases (18%) were sports related included skiing (42 cases), football (23 cases), soccer (8 cases), basketball (6 cases), ice hockey (2 cases), track (2 cases) and volleyball (1 case). The other major cause of SPN entrapment is lateral (inversion) ankle sprains [63].…”

Section: Examples Of Nerve Entrapment Presenting As Crpsmentioning

confidence: 99%